Zika Threat Is Worse Than Initially Thought, Health Authorities Say
The outbreak of the mosquito-borne Zika virus in Latin America and the Caribbean, which began in May 2015 in Brazil, has raised concerns about a wider spread of the disease across the Western Hemisphere and the impact it may have on businesses and their employees. The World Health Organization (WHO) declared Zika an international public health emergency and the US Occupational Safety and Health Administration (OSHA) began developing interim guidelines for businesses to protect workers from occupational exposure to the Zika virus.
Many organizations are trying to determine the business implications of the outbreak and how to best mitigate potential risks, balancing insurance and risk management approaches for their global operations or employees who live in or are traveling to the Americas.
This outbreak marks the first time the Zika virus has appeared in the Western Hemisphere, and it could spread rapidly through densely populated areas, especially those without adequate mosquito-control measures. The WHO estimates that there could be four million Zika-related cases in the Americas within the next year.
Causes for Concern
The confirmed link between Zika and a spate of birth defects in babies in Brazil and new information about human-to-human transmission of the virus has been the main cause for concern. On April 13, 2016, the Centers for Disease Control and Prevention (CDC) announced that there is enough evidence to confirm that the Zika virus could cause microcephaly and other neurological abnormalities. Several regional health authorities advised women to get tested for Zika and consider postponing child-bearing plans.
The Zika virus is also a growing cause for concern because:
- The link between the spreading Zika virus and microcephaly in the region may cause serious short- and long-term social and economic repercussions, according to industry experts.
- The Zika virus has been linked to patients developing Guillain-Barre syndrome — a rare disorder in which the immune system damages nerve cells, causing muscle weakness and sometimes temporary paralysis. There’s no cure for Guillain-Barre syndrome. Hospitalization is often required, but most people recover.
- There are several cases of human-to-human transmission through sexual contact or blood transfusions. The sexual transmission of the Zika virus to a pregnant partner is of particular concern as are recent cases of transmission from women to men.
Zika Virus Overview
Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito. The virus can also be transmitted through sexual contact, blood transfusions, and from a pregnant mother to her fetus during pregnancy.
According to the CDC, approximately one in five people infected with the virus become ill. The incubation period from infection to the onset of symptoms is about two to seven days after being bitten by an infected mosquito. Signs of illness usually include mild flu-like symptoms such as fever, rash, joint pain, conjunctivitis, and in rare cases, development of Guillain-Barre.
There is no vaccine or specific medicine to treat Zika virus infections, though efforts are now underway to accelerate their development. Symptoms are typically treated through rest, drinking fluids to prevent dehydration, and medicines such as acetaminophen to reduce fever and pain.
As of July 20, the CDC reported 1,403 travel-associated Zika virus cases in the US and 3,815 locally-acquired cases in US territories. These numbers include 400 pregnant women in the US and 378 in US territories. By the end of July, the first local mosquito infection cases were confirmed in Florida.
Though it hasn’t imposed travel bans, the CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. This list includes 49 countries and US territories, including Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Suriname, and Venezuela. Organizations should take this travel alert into consideration when reviewing possible business trips to the region.
The CDC has also issued a travel alert, recommending that pregnant women “consider not going to the Olympics,” which will be held in Brazil in August. It also issued guidelines for how women can protect themselves from mosquito bites should they attend the games and how to prevent sexual transmission from a sexual partner who attends the games. These and other health authority recommendations have impacted athlete attendance at the games and the hotels and entertainment companies involved in the Olympics.
However, the CDC said in a statement released on July 13 that it expects mosquito-borne Zika virus transmission to be low during the Olympics. This is because August and September are winter months in Brazil, when cooler and drier weather typically reduces mosquito populations. Additionally, the CDC noted that “overall travel volume to the Games represents a very small fraction (<0.25%) of the total estimated 2015 travel volume to Zika-affected countries, highlighting the unlikely scenario that Zika importation would be solely attributable to travel to the Games.”
Further, according to a press release from the National Institutes of Health (NIH), researchers will monitor potential Zika virus exposure among a subset of athletes, coaches, and other US Olympic Committee (USOC) staff traveling to Brazil to attend the Olympics and Paralympics. The study will monitor the health and reproductive outcomes of members of the US team for up to one year “to improve understanding of how the virus persists in the body and to identify potential factors that influence the course of infection.”
Travelers can protect themselves from the Zika virus by preventing mosquito bites by:
- Using insect repellent.
- Wearing long sleeves and pants.
- Staying in places with air conditioning or that use window and door screens.
People living in Zika-impacted countries should take similar measures and also seek to eliminate from their personal properties or workplaces any standing pools of water (even in potted plants), which can be breeding grounds for mosquitos.
Those who become aware that they have become infected with Zika should avoid being bitten by mosquitos during the first week of infection and illness. However, as most people infected with Zika do not feel ill, as a general precaution the CDC recommends that travelers returning from an area with Zika take steps to prevent mosquito bites for up to three weeks so that the virus is not carried to others.
Because there is now evidence that Zika can be spread by both men and women through sexual contact, the CDC strongly recommends that men who have traveled to Zika-affected areas and who have pregnant partners either use condoms during sex or abstain from sex for the duration of the pregnancy. The CDC now recommends that non-symptomatic partners should wait eight weeks after traveling to an area with Zika before practicing unprotected sex and for six months should one or both of the partners have symptoms of a Zika infection.
Health authorities in Brazil, Ecuador, El Salvador, Colombia, and Jamaica have recommended women delay pregnancy. It is also recommended that pregnant women or those seeking to become pregnant carefully consider [or refrain] from trips to countries where Zika is prevalent. This now includes Puerto Rico, where the health secretary, Dr. Ana Ríus, and the CDC currently advise women in Zika-infected areas to avoid pregnancy.
Protecting Your Business
- If an employee contracts Zika during the course of employment, workers’ compensation insurance would likely provide coverage for costs related to treatment of the illness, lost wages, and, in a worst case scenario, death benefits.
- Employees could be evacuated from a project site where Zika cases arise. An egress plan may be offered by insurers; some foreign liability programs have egress coverage and limits.
- If an employee returning to the US from an impacted region becomes symptomatic, appropriate health screenings that are aligned with the CDC and company policy may be required.
- Employees may refuse to work when there are “any conditions or practices in any place of employment which are such that a danger exists which could reasonably be expected to cause death or serious physical harm immediately or before the imminence of such danger can be eliminated,” according to OSHA. Employees may refuse to work in impacted areas due to Zika fears. Employers should handle such decisions carefully to avoid adverse employment actions.
Stemming the Tide
In the heat of summer, the Aedes mosquitoes are more active and there is a greater risk of the Zika virus spreading in the Northern Hemisphere. In fact, on July 29, Florida health officials confirmed the first cases of individuals infected with the Zika virus by local mosquitoes in Dade and Broward counties. The four individuals had not traveled to Zika-affected areas nor did they have sexual contact with someone who had been exposed to the virus. By August 1, the number had risen to 14, which prompted the CDC to advise that pregnant women not travel to Miami’s Wynwood neighborhood. This is believed to be the first time the CDC has advised against travel to a continental US location. Additionally, the CDC has deployed an emergency response team, including birth defect and mosquito control experts.
This development also prompted the CDC to award $16 million to 40 states and territories to support information-gathering systems, microcephaly detection, and treatment of other adverse outcomes. This is in addition to the $25 million awarded in July. The CDC noted that this is a stopgap measure, which has diverted funding from other public health resources, until Congress approves of funding.
At a federal level, the Obama administration has asked Congress for $1.8 billion to respond to Zika risks. In June, the $1.1 billion spending bill was blocked and the matter remains under review. In the meantime, states are pursuing their own courses of action with Tennessee, for example, conducting Zika drills and setting up response centers. In Florida, given the recently confirmed local mosquito transmissions, additional spraying and mosquito reduction efforts are occurring in impacted areas, a Joint Information Center within the state’s Emergency Operations Center has been activated, additional funding is being provided for blood donation screening, and educational efforts are increasing.
New York City announced on April 18 that it plans to invest $21 million over the next three years in Zika testing and prevention, an information campaign, mosquito control and surveillance programs, and testing services for pregnant women. Additionally, the city will double the number of mosquito traps and hire new inspectors, exterminators, and lab analysts.
Outside the US, some international airports, particularly those in Asia, have established Zika screenings for travelers returning from affected countries. However, thermal scans and questionnaires may not be effective as many of the infected do not show immediate symptoms and testing for the virus can be complicated. Business travelers should be aware of these new measures as they plan international trips to or from impacted regions.
Brazilian authorities launched a national campaign called “Zika Zero,” aimed to engage the public in controlling mosquito populations in and around their homes, where officials note that more than two-thirds of mosquitoes breed.
Additionally there has been an increase in testing at-risk patients, such as women who are pregnant and symptomatic. The CDC recommends that all pregnant women who have traveled to places with Zika outbreaks get tested. Doctors are also increasingly on the lookout for birth defects and neurologic diseases of fetuses in symptomatic mothers.
What You Can Do Right Now
Although predicting exactly how the outbreak may impact your business is difficult, it is important to consult with insurance advisors to understand how insurance policies may apply. Additionally, you can better prepare for Zika’s impact on your company by:
- Reviewing company policies on travel, hygiene, medical screening, and health support, including the provision of anti-virals, alcohol-based anti-bacterial sanitizer, masks, and items such as recommended insect repellants.
- Providing personnel in high-risk areas with basic safety and awareness tips. For Zika, this includes using insect repellent, wearing long-sleeves and pants, and staying in air-conditioned places or places with window and door screens.
- Reviewing methods for providing ongoing information about the viral threat and the status of business operations to employees at work and at home.
- Addressing the continuity requirements to keep vital operations going, including ways to minimize exposure to and the spread of illness in the workplace.
- Reviewing the corporate structure necessary to manage the consequences of a potential outbreak, including implementing multiple business continuity and response plans, coping with a major increase in the number of employees working from home or unable to work, and addressing business strategy and operational impacts due to substantial changes to the marketplace and supply chain.
The containment of the Zika virus will soon be further complicated by the upcoming Olympics and warmer weather in the Northern Hemisphere. By taking the time to review your insurance, risk management, business continuity, and other response and crisis management plans, you can help ensure your organization is mitigating Zika-related risks, current and future.